[Medical clearance for missions abroad (EEU): definitions, recommendations for use and performance]. / Entsendungseignungsuntersuchung (EEU): Definition, Empfehlungen zum Untersuchungsaufwand und Einsatz.

Standards for medical clearance for private or business missions abroad are--at least in the German speaking countries--not clearly defined and mostly derived from the old terminus "Tropentauglichkeit" which means fit for mission in the tropics. The authors now define a new standard, called "Entsendungstauglichkeitsuntersuchung" which means clearance of fitness for all types of missions abroad, independent of distinct climatic zones. To meet the inhomogenous requirements of different institutions and different types of missions the medical examination proposed follows a modular structure to optimize economic and medical use of resources. Moreover, as Austria, Germany and Switzerland have different legal and economic postulates, the medical examination has to be adapted to the different premises. The definition and description of this special type of "medical clearance for missions abroad" is supplemented by recommendations for definitions of clients who should undergo such an investigation and the professionals who should perform this type of investigation. Additionally, results of this type of medical clearance are defined and prophylactic aspects in terms of pre-travel advice are mentioned.

New vaccination strategies for low- and non-responders to hepatitis B vaccine.

The currently available recombinant hepatitis B vaccines are safe, efficacious and immunogenic. Nevertheless, a high rate of low- and nonresponsiveness to the current vaccine poses a problem since this group remains susceptible to infection with hepatitis B virus. Efforts are underway to develop new vaccines and strategies to enhance seroprotection rates. One possibility under investigation is the low-dose intradermal administration of vaccine since the immune system is well represented in both the epidermis and the dermis. Despite encouraging results concerning the immunogenicity in previous non-responders, the main difficulty is the technique of administration and unacceptable local adverse effects. Promising data have emerged from clinical trials evaluating the immunogenicity of new recombinant vaccines containing the complete pre-S1 and pre-S2 regions of HbsAg and, more recently, of novel adjuvanted hepatitis B vaccines. Future approaches include DNA vaccination and expression of HbsAg determinants in live recombinant vectors.